Pioneering approach to addiction in Rhode Island jails saves lives

(Reuters Health) - An innovative program offering all of Rhode Island’s prisoners methadone and other drugs to treat opioid-use disorders has slashed overdose deaths in the state during its first year, according to a new study.

Overdose deaths dropped 12 percent throughout Rhode Island during the first year of the program - the only one of its kind in the U.S. Even more dramatically, the number of overdose deaths in Rhode Island plunged 61 percent last year among people recently released from jail or prison, researchers report in JAMA Psychiatry.

“Within one year of setting up this program, we have impacted state overdose deaths,” senior author Dr. Josiah Rich said in a phone interview. “That’s unheard of.”

Since July 2016, Rhode Island screens all its inmates for opioid-use disorder and makes available methadone and two other medications for addiction treatment, or MAT, to those who need and want it. The new study reports on results during a period in which more than 300 prisoners had taken advantage of the program.

“This program reaches an extremely vulnerable population at an extremely vulnerable time with the best treatment available for opioid-use disorder,” said Rich, a Brown University professor who directs the Center for Prisoner Health and Human Rights in Providence.

He sees the treatment in jails and prisons, combined with community treatment after release, as a winning strategy for reducing skyrocketing overdose deaths, which totaled more than 63,000 in the U.S. in 2016.

Dr. Kathleen Maurer, medical director at the Connecticut Department of Correction in Wethersfield, praised the program in neighboring Rhode Island as a prototype for the nation.

“What Rhode Island has done is amazing and courageous and very forward-looking, and I think they provide a model for all of us,” Maurer, who was not involved with the study, told Reuters Health.

Previous research has shown that overdose risk peaks immediately after prisoners addicted to opioids are released back into the community. Nonetheless, most U.S. correctional facilities insist that inmates withdraw from medicated-assisted treatment when they enter the system, and most offer no medication upon release.

“Generally, corrections brings people in, they take them off either methadone or heroin, and then they release them with nothing but cravings,” Maurer said.

A 36-year-old East Providence arborist who asked to be identified only by his first name, Casey, knows the drill. He credits the Rhode Island program with helping him get his life back on track and possibly sparing him from the death sentence of street heroin, fentanyl or carfentanyl, which killed a close friend in October.

Casey got hooked on opioids 16 years ago. As a college student, he fractured his spine in a car accident and began taking the OxyContin his doctor prescribed for pain relief. He went from prescription painkillers, to street-purchased pills, to heroin.

For the past eight years, Casey has been on and off methadone, a synthetic opiate that for decades has been used to treat people addicted to opioid painkillers and heroin. But sometimes Casey’s job took him out of town, and he couldn’t make it to the clinic to get his daily dose of methadone, he said in a phone interview. Then he’d turn to street drugs and wind up in jail.

Casey’s been incarcerated four times for possession of narcotics, and three times he was forced to withdraw from methadone only to have to turn around and face another round on the outside unassisted.

When he was arrested in November, he was presented with a new option. He could try Suboxone, a long-acting partial opioid agonist that would not require daily reporting to a clinic, like he had to do for methadone, and he could leave the prison on the medication.

“When I would come out of prison in the past, within a month I would find myself using,” Casey said. Since his release six weeks ago, he said he hadn’t even thought about using heroin.

“I know it’s only been a month and a half,” he said. “But at least I have a shot.”

Rich and his team designed the study as a preliminary evaluation of the program. But the findings - a drop in statewide overdose deaths from 179 in the first six months of 2016 to 157 during the same period in 2017 - convinced the researchers of the urgency to report the results.

For every 11 inmates treated, researchers calculated they prevented one death from overdose.

“This felt so compelling that we felt it was really necessary to get it out,” lead author Traci Green, a Brown University professor of emergency medicine and epidemiology in Providence, said in a phone interview.

“A lot of individuals are able to find their lives,” she said. “The medication is so central to controlling the cravings, they can work on their family, their jobs, re-entry into the community and the broader society.”